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題 名 | Endoscopic Vein Harvest for Coronary Artery Bypass Surgery=藉助內視鏡取大隱靜脈完成冠狀動脈繞道手術 |
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作 者 | 李秋陽; 賴曉亭; 游堂振; 王志軒; | 書刊名 | 中華醫學雜誌 |
卷 期 | 61:5 1998.05[民87.05] |
頁 次 | 頁276-280 |
分類號 | 416.262 |
關鍵詞 | 冠畎動脈繞道手術; 內視鏡組織剝離器; 螢光幕輔助; 內視鏡取大隱靜脈; Coronary artery bypass graft; CABG; Endopath subcutaneous dissector; Video-assisted endoscopic vein harvest; |
語 文 | 英文(English) |
中文摘要 | 背景傷口感染是冠狀動脈繞道手術常發生的併發症;傷口感染不僅增加病情複雜 性,有時甚至導玫敗血症而死亡。所增加住院天數、耗費的人力、物力更是無法估計。 縮小傷口和減少傷口暴露機會是降低感染率、致死率的好方法。本研究使用內視鏡等器械及 螢光幕的輔助,探討術後傷口癒合及恢復情形。 方法本院自1996年10月起,引用內視鏡等器械及螢光幕輔助,取大隱靜脈,已順利完成46名 病例。首先在膝關節內踝下方1公分處,打開2-3公分傷口,以傳統方法分離血管周圍組織 ,找出大隱靜脈走向。再利用內視鏡器械及螢光幕輔助下,由膝關節往鼠蹊部方向,輕巧地 剝離大隱靜脈旁組織,用內視鏡組織剪、血管夾分離血管分枝,完成取下大隱靜脈工作。 結果1996年10月至1997年5月共有156名病人進行冠狀動脈血管繞道手術,其中有50名在內視 鏡器械輔助下取大隱靜脈,有4名因大隱靜脈走向深剖筋膜層,手術中決定改用傳統方法取 血管。而另組106名以傳統方法取血管,比較這兩組差異,發現內視鏡組病人傷口恢復情況 很好,僅有一名病人在鼠蹊傷口處產生血腫,傷口併發症率2%,在傳統組中有14名,傷口併 發症率佔13.2%。內視鏡組平均住院天數較傳統方法平均縮短4.3天。 結論藉由內視鏡器械及螢光幕輔助下,取大隱靜脈的方法,使病人傷口較小、術後疼痛減輕 、傷口併發症減少,下床活動提早,進而縮短住院天數。根據本研究結果,內視鏡器械併用 螢光幕輔助取大隱靜脈的方法,將是未來趨勢。 |
英文摘要 | Background. Despite increased awareness of risk factors, wound complications continue to be a problem following coronary artery bypass graft (CABG) surgery. A minimally invasive alternative was therefore developed to reduce the risk of complications while providing the same benefits as the standard open vein harvest procedure. Methods. Video-assisted endoscopic technique for vein harvest was introduced in our medical center in October 1996. The procedure was evaluated and compared with the standard open vein harvest procedure. With the endoscopic technique, small incisions were made, each about 2-3 cm at the selected access sites (groin and above and below the knee). An endopath subcutaneous dissector was subsequently inserted along the anterior surface of the saphenous vein with the assistance of an endoscope and video monitor. The venous side branches were detected and positioned using a vessel dissector. A ligaclip was applied and the branches were divided using endopath-scissors. In some cases, the venous branches were divided directly using the endopath-scissors. Therefore, the distal and proximal ends of the saphenous vein were isolated, ligated and divided. The harvested veins were used for CABG. Each patient was evaluated for length of surgery, hospital stay and morbidity. Results. From October 1996 through May 1997, we performed 50 procedures using video- assisted endoscopic vein harvest. The results were compared with those from 106 patients who underwent standard open vein harvest during the same period. The rate of complications was 2% in the endoscopic group compared with 13.2% in the open group (p<0.05). The average hospital stay was 7.2 days in the endoscopic group and 11.5 days in the open group (p<0.05). Twelve weeks after the operation, all of the incisions healed with good cosmetic results in the endoscopic group. However, long visible scars were found in the patients in the open group. Conclusions. Endoscopic saphenous vein harvest provides a minimally invasive alternative to open vein harvest. It provides good cosmetic results without a hypertrophic scar and enables the patient to regain early ambulation. |
本系統中英文摘要資訊取自各篇刊載內容。